Factors predicting survival following alloSCT in patients with therapy-related AML and MDS: a multicenter study
Therapy-related myeloid neoplasms (t-MN) are aggressive myeloid neoplasms. Factors predicting post-allogeneic stem cell transplant (alloSCT) survival are not well-known. We studied the prognostic utility of factors at: t-MN diagnosis, pre-alloSCT, and post-alloSCT. Primary endpoints were 3-year over...
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Published in | Bone marrow transplantation (Basingstoke) Vol. 58; no. 7; pp. 769 - 776 |
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Main Authors | , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
London
Nature Publishing Group UK
01.07.2023
Nature Publishing Group |
Subjects | |
Online Access | Get full text |
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Summary: | Therapy-related myeloid neoplasms (t-MN) are aggressive myeloid neoplasms. Factors predicting post-allogeneic stem cell transplant (alloSCT) survival are not well-known. We studied the prognostic utility of factors at: t-MN diagnosis, pre-alloSCT, and post-alloSCT. Primary endpoints were 3-year overall survival (OS), relapse incidence (RI), and non-relapse mortality (NRM). Post-alloSCT OS did not differ between t-MDS and t-AML (20.1 vs. 19.6 months,
P
= 1), though t-MDS had a significantly higher 3-year RI compared to t-AML (45.1% vs. 26.9%,
P
= 0.03). In t-MDS, the presence of monosomy 5 (HR 3.63,
P
= 0.006) or monosomy 17 (HR 11.81,
P
= 0.01) pre-alloSCT were associated with higher RI. Complex karyotype was the only factor adversely influencing survival at all the timepoints. The inclusion of genetic information yielded 2 risk-categories: high-risk defined by the presence of pathogenic variants (PV) in (
TP53
/
BCOR
/
IDH1
/
GATA2
/
BCORL1)
and standard-risk (remainder of the patients) with 3-year post-alloSCT OS of 0% and 64.6%, respectively (
P
= 0.001). We concluded that while alloSCT was curative in a subset of t-MN patients, outcomes remained poor, specifically in the high-risk category. t-MDS patients, especially those with persistent disease pre-alloSCT were at increased risk of relapse. Disease-related factors at t-MN diagnosis were the most prognostic of post-alloSCT survival; utility of factors available later in the course, was incremental. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 0268-3369 1476-5365 |
DOI: | 10.1038/s41409-023-01970-0 |